Provider Demographics
NPI:1164425682
Name:CLAROS-OLIVA, MARIO S (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:S
Last Name:CLAROS-OLIVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 INNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-9123
Mailing Address - Country:US
Mailing Address - Phone:985-892-3225
Mailing Address - Fax:985-234-0628
Practice Address - Street 1:1202 S TYLER ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-898-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022838207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1432105Medicaid
LAH33623Medicare UPIN
LA050084483Medicare PIN
LA1432105Medicaid
LA4A064C993Medicare PIN
LA4A064D228Medicare PIN
LA050084484Medicare PIN